A Digital Patient Decision Aid to Increase Sexually Transmitted Infection Testing in the Emergency Department: The STIckER Study

摘要 改进性传播感染(STI)筛查对于扭转STI在中国的流行至关重要 美国(美国)。在美国，近一半的性传播感染发生在15-24岁的青少年和年轻人(Aya)中，并且 未能进行泌尿生殖道和生殖器外(肛门直肠和口咽部)STI测试导致 疾病的传播。急诊科(ED)每年为1700多万AYA提供护理，其中大部分是 穷人和少数族裔。我们之前的工作表明，在这一人群中，避孕药的使用不一致， 以及，尽管ED提供者接受基于ED的性健康干预措施，但实施障碍 坚持，比如有限的时间和资源。需要创新的干预措施，以有效地适应教育部门 工作流程，并最大限度地进行适当的STI测试。一种这样的干预将是耐心的决策辅助， 向可能受益于STI检测的AYA患者提供信息和授权。患者决策辅助工具已经被用于 成功促进急诊科在不同临床情况下的共同决策。我们聚集了一个多人- 儿科、成人和急诊医学、基于ED的临床试验、数字健康、 实施科学、生物统计和共享决策，以开发贴纸(STI在ER中登记)， 一种基于证据的数字患者决策辅助工具，使用共享决策促进急诊室的STI检测 接近。贴纸由三个步骤组成：(1)患者通过二维码扫描贴纸，从而获得非 评判性健康筛查评估；(2)共享决策教育模块 循证检测建议的个性化STI风险；以及(3)患者-提供者STI的便利化 使用机密的彩色编码数字信息图测试对话。这项提议的具体目的是 (1)为了精炼“贴纸”，我们的STI测试患者通过基于以下内容的迭代开发方法进行决策 根据利益相关者的反馈；(2)进行可用性测试并最终确定贴纸的开发；以及(3) 进行一项试点随机试验，以检验贴纸在急症室的初步效果和实施情况。 我们假设，与贴纸互动的性行为活跃的Aya会更频繁地接受任何STI测试 与性生活活跃的阿雅相比，阿雅不会与贴纸互动。标志：有效的、自动化的 数字干预增加性传播感染检测可以在其他ED中作为一种可重复使用的手段来促进 提供循证的性健康教育，降低性病感染率，改善Aya的健康结果 在美国各地。

ABSTRACT Improved screening for sexually transmitted infections (STI) is essential to reversing the STI epidemic in the United States (US). Nearly half of STIs in the US occur in adolescent and young adults (AYA) aged 15-24, and failure to perform genitourinary and extra-genital (anorectal and oropharyngeal) STI testing contributes to the propagation of disease. Emergency Departments (ED) care for over 17 million AYA each year, the majority being poor and minority. Our prior work demonstrated the inconsistent use of contraceptives among this population, and how, although ED providers are receptive to ED-based sexual health interventions, implementation barriers persist, such as limited time and resources. Innovative interventions are needed that fit efficiently within the ED workflow and maximize appropriate STI testing. One such intervention would be a patient decision aid that informs and empowers AYA patients who may benefit from STI testing. Patient decision aids have been used to successfully facilitate shared decision-making in the ED for various clinical scenarios. We have gathered a multi- disciplinary team of experts in pediatric, adult, and emergency medicine, ED-based clinical trials, digital health, implementation science, biostatistics, and shared decision-making to develop STIckER (STI ChecK in the ER), an evidence-based, digital patient decision aid to facilitate STI testing in the ED using a shared decision-making approach. STIckER consists of three steps: (1) the patient “scanning the sticker” via a QR code leading to a non- judgmental sexual health screening assessment; (2) shared decision-making educational modules connecting personalized STI risk to evidence-based testing recommendations; and (3) facilitation of a patient-provider STI testing conversation using a confidential, color-coded digital infographic. The specific aims of this proposal are (1) To refine “STIckER,” our STI testing patient decision aid through an iterative development approach based on stakeholder feedback; (2) To conduct usability testing and finalize development of STIckER; and (3) To conduct a pilot randomized trial to examine the preliminary efficacy and implementation of STIckER in the ED. We hypothesize that sexually active AYA who interact with STIckER will more often undergo any STI testing compared with sexually active AYA who do not interact with STIckER. SIGINIFICANCE: An effective, automated digital intervention increasing STI testing can be utilized in other EDs as a reproducible means to promote the provision of evidence-based sexual health education, decrease STI rates, and improve AYA health outcomes throughout the US.